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Individual
BROOKE ELLISON CROCKER
Active
Individual
BROOKE ELLISON CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4945
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6503PA
—
SC
01
—
SCQ4528510
MEDICARE PIN
SC
01
—
SCQ4529068
MEDICARE PIN
SC
Enumeration date
05/08/2023
Last updated
08/28/2024
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